Working conditions and supervision for residents in internal medicine programs: recommendations. American College of Physicians.

Changes intended to improve resident working conditions and supervision must take into account the complex realities governing teaching services. The American College of Physicians supports the ongoing reexamination of these issues, and recommends the following: 1) change be systematic and coordinated, balancing patient care and teaching needs; 2) changes in the medical care system itself are necessary in this process; 3) efforts be continued to reduce preventable medical error on teaching services within the limits of uncertainty intrinsic to medical practice; 4) reasonable restriction be placed on total continuous duty hours, but residents not disengage themselves prematurely from care of their patients; 5) residency training specifically teach techniques for balancing patient service, education, and personal life; 6) the issue of resident workload be addressed; and 7) formal evaluation of supervisory competence, explicit attention to the spirit of resident-supervisor relationships, respect for the principle of meaningful patient responsibility, and formal resident credentialing all be taken into account in improving resident supervision.